Golf Doctor (orthopaedics) Achilles Tendinitis - A pain in the heel by Dr. Michael Leighton Dear Golf Doctor: I just finished caddying this weekend for my friend in a celebrity pro-am in Lake Tahoe. Each morning I awoke with excruciating pain and stiffness in my calf and achilles. The pain is about 4 inches above my heel and seems to improve after walking a short while or after a shower. My wife massages the area and it seems to improve, but I think she's had just about enough. What's my problem and how do I get rid of it? Not only is golf suffering, but basketball is a chore, too. I'm 41 and I'm walking like I'm 81. Help me. - David Burke, WPB   Dear David: If your wife is making it better when she massages it, what's the problem? Do you think she's "had enough" because she's tired of giving you manual therapy or because you were away for five days at Tahoe with a bunch of celebs, yucking it up? Then again, this column is the "Golf Doctor," not "Dr. Ruth!" I believe what you have is achilles tendinitis. Frequently, people get insertional tendinitis at the heel bone (where the shoe rubs), but in many athletes, the pain can be higher up. The achilles tendon is formed by three groups of muscles (gastroc, soleus, and plantaris), and contraction causes the foot to go down. Various overuse injuries or chronic repetitive motions can cause tendon inflammation. This is manifested as pain and morning stiffness and, on occasion, a palpable painful swelling in the area. Examination often reveals a tight achilles (heel cord) and it may be bilateral. The treatment for diseases of tendons revolves around modification of activity; specifically, rest. This is usually unacceptable to active athletes and other modalities are employed. Your physician may prescribe a short course of nonsteroidal anti-inflammatory drugs (ibuprofen, etc.). Further treatment, usually done by a physical therapist, includes friction massage to increase blood flow, ice to decrease inflammation, and iontophoresis to pulse low doses of steroids around the tendon. Injections of steroids are extremely controversial and in no case should they be injected into the tendon. Evaluation of cases that do not respond to these conservative modes may be evaluated by MRI. If an area of significant tendon degeneration is present, surgical debridement and repair (clean out) may be indicated. This should be a long-standing problem prior to operative intervention. Achilles tendinitis can be quite a nuisance. In the weekend warrior, early identification and treatment should get you back to the links. I could use a good caddie. Michael Leighton, M.D. is an avid golfer who specializes in orthopaedic surgery and sports medicine. He can be reached at Atlantis Orthopaedics, 561-967-4400 or by e-mail at KNEESURG@aol.com